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What hurts? - Shoulder
Andrew Green, MD
Chief of Shoulder and Elbow Surgery
The shoulder can be described as several joints that combine with tendons and muscles to allow a full range of motion to the arm, from scratching your back to throwing the perfect pitch. Mobility may come with a price, however. The shoulder movement can lead to increasing problems with instability or impingement of soft tissue resulting in pain. Pain may be felt only when the shoulder is moved, or all of the time. The pain may be acute and disappear in a short time, or it may continue and require medical diagnosis and treatment.
Common causes of pain
Rather than bones, many shoulder problems involve the soft tissues, muscles, ligaments, and tendons. A majority of these problems fall into three major categories:
Other much more rare causes of shoulder pain are tumors, infection and nerve-related problems.
A tendon is a cord which connects muscle to bone or other tissue. Similar to the wearing process on the sole of a shoe which eventually splits from overuse, most tendinitis is a result of the wearing process that takes place over a period of years. Typically, tendinitis is one of several types:
Acute tendinitis following some overuse problem such as excessive ball throwing and other sports- or work-related activities.
Chronic tendinitis which can be attributed to degenerative disease or repetitive wear and tear due to age.
The splitting and tearing of tendons which may result from acute injury or degenerative changes in the tendons due to advancing age. Rotator cuff injuries are among the most common of these disorders. The rotator cuff is composed of muscles and their tendons which provides shoulder motion and stability.
In some cases, excessive use of the shoulder leads to inflammation and swelling of a bursa, a condition called bursitis. Bursas are often described as fluid-filled sacs located around the joints which lessen the friction caused by movement of the shoulder. Bursitis usually occurs in association with rotator cuff tendinitis. Sometimes the many tissues in the shoulder become inflamed and painful, which in turn may limit the use of the shoulder. The joint may stiffen as a result, a condition known as a "frozen shoulder." The good news is that with appropriate care, this condition will usually resolve itself.
Injury / Instability
Sometimes the bones in one of the shoulder joints move (or, in an injury, are forced) out of their normal position. This condition, instability, can result in dislocation of one of the joints in the shoulder. Recurring dislocations, which may be partial or complete, cause pain and unsteadiness when you raise your arm or move it away from your body. When you lift your arm over your head, the shoulder may feel as if it is slipping out of place or an uncomfortable, unusual feeling that some people refer to as having a "dead" arm.
Shoulder pain may also result from arthritis. There are many types of arthritis, but generally it involves wear and tear changes with inflammation of the joint, causing swelling, pain and stiffness. Arthritis may be attributed to sports or work injuries.
People will often avoid shoulder movements in an attempt to lessen the pain arising from these conditions. Unfortunately, this can lead to a tightening or stiffening of the soft tissue parts of the joint, resulting in a painful restriction of motion.
Arthroscopic Rotator Cuff Repair
This surgery is designed to reattach torn tendons in the shoulder. Small incisions are made around the shoulder and a camera called an arthroscope is inserted. The surgeon will perform a debridement, which removes any debris from the cuff tendon. Throughout the process the surgeon will determine how much surgery actually needs to be performed based on the condition of the shoulder. The surgeon may need to smooth down the bottom of the acromion if bone spurs have formed. If there is a torn rotator cuff tendon, a small area on the humerus is cleared and anchors are screwed into place to hold the stitches in place on the arm bone. The tendon is stitched together and pulled against the anchors for support. This procedure reattaches the tendon to the humerus. Your bone will naturally reattach the tendon to the humerus bone and physical therapy will be needed to regain strength in the shoulder.
Shoulder Impingement Surgery
The procedure is usually performed arthroscopic-ally and is designed to allow for pain free motion of the shoulder. The surgery essentially gives more room for the rotator tendon to move. Small incisions are made and an arthroscope is inserted to give a clear view of the shoulder. The inflamed bursa tissue is removed and the impinging coracoacromial ligament is cut. The small hooked section of the acromion bone is shaved down to allow for space. The incisions are stitched together and physical therapy will be needed to regain strength in the shoulder.
Dr. Green, Chief of Shoulder and Elbow Surgery at University Orthopedics, talks about his specialties.